Systematic review and meta-analyses:Fever in pregnancy and health impacts in the offspring

BACKGROUND AND OBJECTIVE:Fever during pregnancy has been suspected to harm the developing fetus. However, until now, no systematic analysis of the available evidence has been undertaken to assess the impact of maternal fever on health outcomes in the child. The goal of this study was to systematically review evidence from epidemiologic studies on adverse health outcomes of the offspring in relation to exposure to maternal fever during pregnancy.METHODS:Systematic searches in PubMed, Web of Science, and the Cochrane Library were performed by using Medical Subject Headings, Boolean operators, and truncation, and references of references were reviewed. Cohort and case-control studies addressing health outcomes of prenatal fever exposure in humans were eligible for inclusion. Studies with no direct reference to fever, studies in selected populations (eg, preterm births), and studies published before 1990 were excluded.RESULTS:The available literature supported an increased risk of adverse offspring health in association with fever during pregnancy. The strongest evidence was available for neural tube defects, congenital heart defects, and oral clefts, in which meta-analyses suggested between a 1.5- and nearly 3-fold increased risk with fever exposure in the first trimester. We did not find strong evidence of a dose–response relationship, but there was some evidence that antipyretic medications may have a protective effect when used in relation to febrile episodes.CONCLUSIONS:We found substantial evidence to support the contention that maternal fever during pregnancy may negatively affect offspring health. The harmful effects seemed to cover both short- and longer-term health outcomes; however, for several outcomes, the evidence was insufficient to judge any association.</jats:sec

Fatigue and workload among Danish fishermen

BACKGROUND: Fishery is a hazardous occupation and fatigue may contribute to the observed risks. This study aims to investigate the association between workload and fatigue among Danish fishermen.MATERIALS AND METHODS: The cross-sectional survey of demographic characteristics and self-reported exposure and health data was performed on a random sample of 270 active fishermen. We applied the validated Multidimensional Fatigue Inventory (MFI-20) to assess the degrees of the different dimensions of perceived fatigue. We estimated physical workload using questions regarding the frequency of seven physical work activities and analysed the association between fatigue and workload using multiple linear regressions.RESULTS: The mean fatigue scores were 9.18 (SD 3.58) for general fatigue, 9.05 (SD 3.36) for physical fatigue, 7.57 (SD 3.03) for reduced activity and 7.16 (SD 3.07) for mental fatigue. Highest levels of fatigue were observed among fishermen at Danish seiners (mean 10.21), and fatigue scores decreased with more days at sea. However, none of these results were significant. Adjusted analyses showed that physical workload was significantly related to general fatigue (b = 0.20, 95% CI: 0.12-0.28), physical fatigue (b = 0.10, 95% CI: 0.04-0.16) and mental fatigue (b = 0.09, 95% CI: 0.01-0.16). Reduced activity was unrelated to work exposures.CONCLUSIONS: General fatigue was the dominant fatigue dimension among Danish fishermen and it is mostly associated with physical workload. Physical workload was additionally significantly associated to the levels of physical and mental fatigue. Fishermen had a lower average score for all fatigue dimensions compared to those seen in general Danish working population. Prospective studies are required to assess whether the identified associations are causal.</p

Health-risk behaviour in deprived neighbourhoods compared with non-deprived neighbourhoods:a systematic literature review of quantitative observational studies

There has been increasing interest in neighbourhoods' influence on individuals' health-risk behaviours, such as smoking, alcohol consumption, physical activity and diet. The aim of this review was to systematically review recent studies on health-risk behaviour among adults who live in deprived neighbourhoods compared with those who live in non-deprived neighbourhoods and to summarise what kind of operationalisations of neighbourhood deprivation that were used in the studies.PRISMA guidelines for systematic reviews were followed. Systematic searches were performed in PubMed, Embase, Web of Science and Sociological Abstracts using relevant search terms, Boolean operators, and truncation, and reference lists were scanned. Quantitative observational studies that examined health-risk behaviour in deprived neighbourhoods compared with non-deprived neighbourhoods were eligible for inclusion.The inclusion criteria were met by 22 studies. The available literature showed a positive association between smoking and physical inactivity and living in deprived neighbourhoods compared with non-deprived neighbourhoods. In regard to low fruit and vegetable consumption and alcohol consumption, the results were ambiguous, and no clear differences were found. Numerous different operationalisations of neighbourhood deprivation were used in the studies.Substantial evidence indicates that future health interventions in deprived neighbourhoods should focus on smoking and physical inactivity. We suggest that alcohol interventions should be population based rather than based on the specific needs of deprived neighbourhoods. More research is needed on fruit and vegetable consumption. In future studies, the lack of a uniform operationalisation of neighbourhood deprivation must be addressed

Association between one's own consumption and harm from others' drinking:Does education play a role?

Introduction: We examined (a) whether risky drinking behaviour is related to experienced harm from others' drinking (EHFOD) and (b) whether any found relationship is modified by educational level, such that those of lower socio-economic status (SES) experience more harm even when adjusted for drinking behaviour. Method: Data from the Danish national alcohol and drug survey of 2011 (N=5133) were linked with registry data from Statistics Denmark. Eight EHFOD indicators were grouped into nuisance, harassment or harm/damage categories. Indicators for mean alcohol consumption, Alcohol Use Disorder Identification Test (AUDIT) and binge drinking were examined in relation to respondents' EHFOD with multiple logistic regression, stratified by sex and education (proxy for SES). Results: One-year prevalence of EHFOD was 50%. We found a positive and significant relationship between own alcohol consumption and EHFOD categories of harassment as well as harm/damage. Effect modification of education was significant for harassment. Among men, odds ratios for the association between risky drinking behaviour and harassment were 5.50 (95% confidence interval (CI) 3.49-8.65) in the low educational group versus 1.42 (95% CI 0.98-2.07) in the high educational group. Conclusions: Our study confirmed an overall positive relationship between EHFOD and drinking behaviour, but it varied by type of EHFOD. Furthermore, education modified this effect for harassment, suggesting evidence of the alcohol harm paradox with respect to EHFOD. More research is necessary to understand better how drinking patterns diverge between low and high educational groups as well as sex, and how this differentially affects risk for alcohol-related harms, including EHFOD.Introduction: We examined (a) whether risky drinking behaviour is related to experienced harm from others’ drinking (EHFOD) and (b) whether any found relationship is modified by educational level, such that those of lower socio-economic status (SES) experience more harm even when adjusted for drinking behaviour. Method: Data from the Danish national alcohol and drug survey of 2011 (N=5133) were linked with registry data from Statistics Denmark. Eight EHFOD indicators were grouped into nuisance, harassment or harm/damage categories. Indicators for mean alcohol consumption, Alcohol Use Disorder Identification Test (AUDIT) and binge drinking were examined in relation to respondents’ EHFOD with multiple logistic regression, stratified by sex and education (proxy for SES). Results: One-year prevalence of EHFOD was 50%. We found a positive and significant relationship between own alcohol consumption and EHFOD categories of harassment as well as harm/damage. Effect modification of education was significant for harassment. Among men, odds ratios for the association between risky drinking behaviour and harassment were 5.50 (95% confidence interval (CI) 3.49–8.65) in the low educational group versus 1.42 (95% CI 0.98–2.07) in the high educational group. Conclusions: Our study confirmed an overall positive relationship between EHFOD and drinking behaviour, but it varied by type of EHFOD. Furthermore, education modified this effect for harassment, suggesting evidence of the alcohol harm paradox with respect to EHFOD. More research is necessary to understand better how drinking patterns diverge between low and high educational groups as well as sex, and how this differentially affects risk for alcohol-related harms, including EHFOD

The workload of fishermen: a cross sectional survey among Danish commercial fishermen

Background: Fishery has always been perceived as a physically demanding industry of a manual character. In recent years the physical work environment has developed positively and consequently the current situation in not fully described in the existing literature. This study aims to describe the work environment of Danish fishermen with regard to their physical workload and ergonomic factors. Materials and methods: A cross sectional study was performed on a random sample of active Danish commercial fishermen (response rate: 28%) by means of a questionnaire on demographic and self-reported occupational and health data. Questions covering the physical workload were related to seven different work situations and a score summing up the workload was developed for the analysis of the relative impact on different groups of fishermen. Results: Almost all fishermen (96.2%) were familiar to proper lifting techniques but only 55.4% used them in their daily work. Standing work was the most applied work position (81.8%), while repetitive hand and finger movements and twisting and bending in the back were other frequent work situations. Deckhands had higher workload scores than skippers, while crew on Danish seiners had higher workload scores than fishermen in other vessel types. Conclusions: Despite improved work environment in the Danish fishing industry, fishermen still experience high levels of workload and suboptimal ergonomic conditions, which are known to cause pain and impair musculoskeletal health. To address the specific areas of fishing with the highest workload, future investments in assistive devices to ease the demanding work and reduce the workload, should particularly address deckhands and less mechanized vessels.

Prevalence and predictors of musculoskeletal pain among Danish fishermen:results from a cross-sectional survey

BACKGROUND: Fishermen work in a physically challenging work environment. The aim of this analysis was to estimate the prevalence and predictors of musculoskeletal pain among Danish fishermen.METHOD: A cross-sectional survey in a random sample of Danish fishermen was done with application of the Nordic questionnaire regarding musculoskeletal pain considering lower back, shoulders, hand neck, knee, upper back elbow, hip and feet. In total, 270 fishermen participated in the study (response rate: 28%). Workload, vessel type, skipper, duration of work, sideline occupation, days/weeks of fishing at sea, age, BMI and education were used as predictors for the overall musculoskeletal pain score (multiple linear regression) and for each single pain site (multinomial logistic regression).RESULTS: The prevalence of pain was high for all musculoskeletal locations. Overall, more than 80% of the responding Danish fishermen reported low back pain, which in 37% lasted for a minimum of 30 days during the past year. In the multiple linear regression analysis, middle workload was associated with a 32% (95% CI: 19-46%) and high workload with 60% (95% CI: 46-73%) increased musculoskeletal pain score compared to low work load. Multinomial logistic regression models showed that workload was the only predictor for all pain sites, in particular regarding upper and lower limb pain.CONCLUSION: Although changes were implemented to improve the fishermen's work environment, the work continues to be physically demanding and impacting their musculoskeletal pain. Potential explanation for this unexpected result like increased work pressure and reduced financial attractiveness in small scale commercial fishery needs to be confirmed in future research.</p

Reasons for participation and non-participation in colorectal cancer screening

Objectives: The aim of the present analysis is to identify the reasons for accepting or rejecting the invitation to be screened by the Faecal Immunochemical Test as part of the free Danish screening programme for colorectal cancer (CRC). Study design: A cross-sectional representative survey of 15,072 Danish citizens aged 50–80 years was collected in 2019 via a Web-based questionnaire administered by Statistics Denmark. Among the net sample of 6807 respondents (45%), 177 were excluded because of current treatment for colorectal disease. Methods: To determine the reasons for accepting or refusing the invitation to be screened for CRC, a latent class analysis was conducted, which allowed participants to provide several reasons for acceptance or rejection of screening. Results: The most important reason for participating in CRC screening was the active public programme. A further reason for participation was the perceived risk for CRC, mainly in combination with the public programme. The reasons for participation did not differ between individuals who had participated and those who intended to participate when offered. Among participants who declined screening, the most frequent reasons were that they forgot to participate or that they were concerned about the unpleasant test procedure. Among individuals who intended to decline screening, a perceived low risk for CRC was the most frequently cited reason. Conclusions: Recommendation from a general practitioner (GP) was not given as a frequent reason for CRC screening participation which is discussed as a challenge to participation rates in population based screening program The main reasons reported for non-participation in CRC screening (i.e. forgot to participate or the unpleasant test procedure) might be addressed by a stronger endorsement from GPs.</p

Milk consumption and the risk of type 2 diabetes:A systematic review of Mendelian randomization studies

Aims: Previously, no relationship between milk consumption and the risk of type 2 diabetes has been found in prospective cohorts. However, Mendelian randomization allows researchers to almost bypass much residual confounding, providing a more precise effect estimate. This systematic review aims to investigate the risk of type 2 diabetes and levels of HbA1c by assessing all Mendelian Randomization studies investigating this subject matter.Data synthesis: PubMed and EMBASE were searched from October 2021 through February 2023. Inclusion and exclusion criteria were formulated to filter out irrelevant studies. Studies were qualitatively assessed with STROBE-MR together with a list of five MR criteria. Six studies were identified, containing several thousand participants. All studies used the SNP rs4988235 as the main exposure and type 2 diabetes and/or HbA1c as the main outcome. Five studies were graded as “good” with STROBE-MR, with one graded as “fair”. For the six MR criteria, five studies were graded “good” in four criteria, while two studies were graded “good” in two criteria. Overall, genetically predicted milk consumption did not seem to be associated with an increased risk of type 2 diabetes. Conclusions: This systematic review found that genetically predicted milk consumption did not seem to increase the risk of type 2 diabetes. Future Mendelian randomization studies concerning this topic should consider conducting two-sample Mendelian Randomization studies, in order to derive a more valid effect estimate.</p

Academic stress in Danish medical and health science students during the COVID-19 lock-down

INTRODUCTION: COVID-19 has disrupted normal life and resulted in an online transformation of teaching. Little is known about how these changes affected academic stress in students. This study examined the role of changes of teaching methods on academic stress among university students during the first lockdown in Denmark.METHODS: The cross-sectional survey was part of the international “COVID-19 International Student Well-being Study” and included responses on socio-economic characteristics, infection worries, academic stress, work capacity and satisfaction with teaching from 1,541 Danish health and medical science university students in May-June 2020. Changes in academic stress were analysed using descriptive statistics and multi-variable analyses using stepwise logistic regression.RESULTS: A considerable part (39%) of students reported academic stress due to COVID-19. One third reported that their study workload had increased significantly due to the COVID-19 outbreak and that they were concerned about their ability to complete the academic year. Factors associated with academic stress were female sex, young age, bachelor level, knowing a COVID-19 patient and being worried about becoming infected, whereas immigration background, sufficient financial resources and living arrangements were not.CONCLUSIONS: Our findings suggest that the COVID-19 outbreak has influenced university students’ academic stress. It is important to set up structures to support students’ mental health and educational trajectory during the pandemic.INTRODUCTION: COVID-19 has disrupted normal life and resulted in an online transformation of teaching. Little is known about how these changes affected academic stress in students. This study examined the role of changes of teaching methods on academic stress among university students during the first lockdown in Denmark.METHODS: The cross-sectional survey was part of the international “COVID-19 International Student Well-being Study” and included responses on socio-economic characteristics, infection worries, academic stress, work capacity and satisfaction with teaching from 1,541 Danish health and medical science university students in May-June 2020. Changes in academic stress were analysed using descriptive statistics and multi-variable analyses using stepwise logistic regression.RESULTS: A considerable part (39%) of students reported academic stress due to COVID-19. One third reported that their study workload had increased significantly due to the COVID-19 outbreak and that they were concerned about their ability to complete the academic year. Factors associated with academic stress were female sex, young age, bachelor level, knowing a COVID-19 patient and being worried about becoming infected, whereas immigration background, sufficient financial resources and living arrangements were not.CONCLUSIONS: Our findings suggest that the COVID-19 outbreak has influenced university students’ academic stress. It is important to set up structures to support students’ mental health and educational trajectory during the pandemic

To do or not to do - a survey study on factors associated with participating in the Danish screening program for colorectal cancer

BACKGROUND: Screening programs for colorectal cancer (CRC) exist in many countries, and with varying participation rates. The present study aimed at identifying socio-demographic factors for accepting a cost-free screening offer for CRC in Denmark, and to study if more people would accept the screening offer if the present fecal test was replaced by a blood test.METHODS: We used a cross-sectional survey design based on a representative group of 6807 Danish citizens aged 50-80 years returning a fully answered web-based questionnaire with socio-demographic data added from national registries. Data were analyzed in STATA and based on bivariate analyses followed by regression models.RESULTS: Danes in general have a high level of lifetime participation (+ 80%) in the national CRC screening program. The results of the stepwise logistic regression model to predict CRC screening participation demonstrated that female gender, higher age, higher income, and moderate alcohol intake were positively associated with screening participation, whereas a negative association was observed for higher educational attainment, obesity, being a smoker, and higher willingness to take health risks. Of the 1026 respondents not accepting the screening offer, 61% were willing to reconsider their initial negative response if the fecal sampling procedure were replaced by blood sampling.CONCLUSION: The CRC screening program intends to include the entire population within a certain at-risk age group. However, individual factors (e.g. sex, age obesity, smoking, risk aversity) appear to significantly affect willingness to participate in the screening program. From a preventive perspective, our findings indicate the need for a more targeted approach trying to reach these groups.</p